Best EDs Focus on Flow

And for Phil Newbold, president and CEO of the 350-staffed-bed Memorial Hospital Health System in South Bend, Ind., and 260-staffed-bed Elkhart (Ind.) General Hospital, it was no surprise that more than four in 10 respondents were concerned about patient safety in the ED. Among the 46% who said they have overcrowded EDs, nearly all respondents said they are concerned about safety issues.

"I think safety is a big concern as more older people with medical problems will be sicker and showing up in the ED, and all this means everyone is going to take longer to go through the system," says Newbold.

As health systems try to improve their EDs, healthcare leaders are watching the financial framework with caution. About 80% said they expect their ED reimbursement margins will worsen as a result of healthcare reform, and 78% said their reimbursement also will get worse. Those factors coupled with an expected increase in the uninsured patient population are a formula for uncertainty for administrators running an ED, according to Gary Tiller, CEO of Ninnescah Valley Heath Systems, which operates the 25-staffed- bed Kingman Community Hospital, 35 miles west of Wichita, Kan.

"We are going to get overrun," Tiller says, predicting an influx of patients who want to use the ED in the wake of healthcare reform. "I don't know if we are going to be able to handle it, truth be known. It's going to be a mess. The thing is we, like everyone else, don't have enough primary care doctors, so we're looking at beefing up on our mid-level physician assistants and other providers to assist. We have our waiting times now in the ED at 54 minutes, but we may be seeing them at two or three hours again, so we're recruiting more doctors for the ED."